The nation’s fourth largest jail resides in Harris County, with a population of about 9,000 inmates. The Harris County Sheriff’s Office (HCSO) says a quarter of those inmates suffer from some form of mental illness.

To help alleviate a slew of problems that come with over-jailing or over-hospitalizing people who have a mental illness, the sheriff’s department unveiled a Telepsychiatry pilot program. Since its launch in December, the program has garnered attention from California to Canada. Harris County officials believe it’s one of the first programs of its kind, if not the first program of its kind.

The new initiative connects deputies in the field with counselors and psychiatrists on iPads.

Mental health and law enforcement

Harris County Sheriff’s Deputy Jose Gomez is part of the Crisis Intervention Response Team (CIRT). It operates in collaboration with the Houston Police Department, and is also under The Mental Health & Jail Diversion Bureau: the newest bureau at the Harris County Sheriff’s Office.

“Mental health calls are very, very dangerous for law enforcement,” said Gomez. “People in that type of situation are very, very unpredictable…. Unfortunately we meet them in their darkest moments, and we try to bring light into that situation.”

Deputy Gomez responds to a call, as part of the Crisis Intervention Response Team, on July 13, 2018.

The pilot program is wrapping up Phase II, which tests different software and utilizes counselors from The Harris Center for Mental Health and IDD, rather than only psychiatrists. The same local mental health authority is already involved with CIRT.

Gomez said, so far, people have been receptive to the iPads.

“Sometimes they won’t talk to police officer or be honest with us- but when you offer that option to talk to someone else- maybe via iPad- they’ll be more honest with the clinician or psychiatrist that they are, indeed, suicidal or they’re actually hearing voices, or they’re in a mental health crisis,” said Gomez.

Phase I revealed a savings of $26,244 over the span of 30 calls, according to an analysis by The University of Texas School of Public Health in Houston. It cited savings from either jail diversion, avoiding hospital transportation, or by not activating other crisis resources.

Gomez’ partner, Michael Hawkins, is a licensed counselor, who normally patrols with him and is on scene for calls. But during Phase II of this program, he is communicating with Gomez and citizens via the iPad.

Deputy Gomez gives an iPad to a woman for assessment on July 13, 2018.

Hawkins has been responding to calls with the Crisis Intervention Response Team for over a decade, and is new to this process with the sheriff’s office.

“We are able to be there at the person’s worst time in their life and intervene and help and give then comfort and aid at that time, that they’re having extreme distress,” said Hawkins. “And it’s a really privilege to be a part of this, whether it’s on iPad or in a patrol car.”

Deputy Jose Gomez and clinician Michael Hawkins reconnect after an in-field assessment using the iPad on July 13, 2018.

Since Harris County is so large, at over 1,700 square miles, there is potential for a lot of travel time when responding to calls. This program minimizes some of that, and allows clinicians to be immediately available to other deputies who may need assistance.

Although, Hawkins said, it’s a little more challenging to establish rapport over an iPad. But he’s going to try to overcome that, he said.

“As a clinician and a counselor, I prefer to be face-to-face. Because I can pick up on so many different things and establish rapport,” said Hawkins. “But I definitely can see benefits, absolutely, of time and manpower of this program.”

Telepsychiatry has been used in various jails and prisons for a while, and this new pilot is based on the Houston Fire Department’s ETHAN project, which stands for Emergency Tele-health and Navigation. It connects EMS personnel with doctors, in order to better triage in the field.

And Program Manager Frank Webb, of HCSO’s Bureau of Mental Health and Jail Diversion, said the same model can be effective to assess mental health situations.

“Hospital emergency departments across the nation are being inundated with people mental health problems brought in by law enforcement,” said Webb. “Medical directors at a lot of these hospitals have told me a lot of these people don’t need to be there.”

A concerned mother talks with a psychiatrist via an iPad about her teenage daughter, during Phase I of the HCSO Telepsychiatry pilot program.

Webb said the ability to bring mental health care straight to people who need it is key. He recounted a call during Phase I, with a teenage daughter who reportedly had suicidal thoughts. The mother was concerned, because she couldn’t get an appointment with a psychiatrist for another two weeks.

“Her daughter got worse, so she called… and she was able to actually talk to the psychiatrist via the iPad in her bedroom- both the mother and the daughter,” said Webb. “So, it’s pretty amazing that you can bring psychiatry into someone’s house.”

The first two phases only involved three deputies for a few dozen calls. If all goes as planned, the next phase is a 6 month initiative involving 25 deputies, said Webb.